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Nursing Homes and Senior Housing Options

One of the most challenging realizations of caring for a loved one comes when you realize that you can no longer take care of them in a way that ensures their safety and quality of life. It’s a natural impulse and desire that, as we age, we long to be in the comforts and familiarities of home. This fact is doubly true for those with dementia or other neurological disorders that can cause even familiar places to seem unfamiliar.

If and when that time comes to move parents out of homes and into assisted living facilities or other senior housing, several considerations need to be made. At the end of the day, we need to know that our loved ones are getting the care they need. In this article, we’re going to discuss some of the broader points surrounding nursing homes and assisted living facilities, some considerations you should make when choosing the right facility, potential alternatives to assisted living, and more. Let’s get into it.

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What Is a Nursing Home?

Before we get into some of the finer points of senior living situations, it’s vital that we start with a baseline definition of what we’re talking about when we say “nursing home” and “assisted living facility.” For a long time, these terms were used interchangeably. In recent years, nursing homes have come to mean residences for older adults that require 24/7 care, while assisted living facilities are residences for seniors who need help with day-to-day activities, but don’t necessarily require constant care.

What Makes an Assisted Living Facility

Assisted living facilities are much more akin to a supervised cooperative housing environment. Many assisted living facilities offer group events like happy hours, restaurant-style dining, outings like group trips to a store, and help with daily living activities like laundry and housekeeping services. Additionally, assisted living facilities will have medical staff on hand. Still, their primary function may not be intended towards consistent palliative care, but rather towards help with day-to-day tasks like medication management and bathing, which can be difficult as we age.

Distinguishing Nursing Homes

By contrast, nursing homes offer some of the features of assisted living facilities like individual suites, but the function is much more geared towards medical care. As a result, nursing homes are often interchangeably referred to as convalescent homes. At a nursing home, residents are given the same assistance as assisted living facilities with respect to helping with day-to-day activities like medication management, laundry, housekeeping, and bathing, but they may also receive more specialized care like routine rehabilitative therapy, occupational, speech, and physical therapy, palliative, and preventative care, in addition to dental care and other medical care. Because care in nursing homes is much more constant and more medically focused, they also come with a higher price tag than assisted living facilities, which we’ll cover more later.

Quick Fact: Palliative care is an interdisciplinary branch of medicine that works to treat pain symptoms, not illnesses themselves.

At What Point Should You Consider a Nursing Home?

In reality, there is no right answer when it comes to putting an older loved one in an assisted living facility or nursing home. The decision will largely depend on your finances, your time commitment to being a caregiver, and the overall health and prognosis for the older adult in question.

The decision to put a parent in a nursing home or assisted living facility is a tough one, and it’s largely met with a mix of guilt and relief. It’s easy to say, “I’ll never put my mom in a nursing home,” but the reality is that in some cases, the care you can offer as a caregiver isn’t sufficient to let your loved one live safely. It’s a trade-off. Older adults may be required to sacrifice a certain level of independence to help ensure their safety and health for years to come.

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Some of the keys to determining the necessity for placement in an assisted living facility or nursing home are whether or not the older adult sees a spike in hospitalizations. If living independently causes some costly hospital stays, the cost of placement in an assisted living facility or nursing home may outweigh the financial cost of hospital stays. Another factor is mental and physical capacity. If living independently poses a constant risk to an older adult’s health and you’re unable to provide that care yourself, it may be time to consider alternative living arrangements.

While the older adult may disagree with the decision, it’s important to remember that the decision isn’t solely up to them. The decision to place them in a nursing home or assisted living facility should be made collectively, with everyone’s needs fully considered. It’s also important to remember that not only is this decision the end-all-be-all—a parent can be placed in a nursing home, recover, and return to their homes as they regain the ability to care for themselves (with your help)—but it’s also not the end of your caregiving. Even though your loved one may be in a nursing home, your role as a caregiver is never abdicated entirely, though it may shift.

Making the Transition to a Nursing Home

Transitioning to a nursing home or assisted living facility can be an intense process, one that affects both senior and caregiver alike. There are steps that can be taken, however, to ease the process for both parties.

Easing the Transition for Older Adults

Think about what it was like going off to college and living in the dorms for the first time, or your first day of high school. Entering a new community full of strangers is scary. Now, compound that fear with a confrontation of your own mortality and a change in lifestyle that you may have had for more than half a century. The transition from home to a facility is profound for many older adults.

As a caregiver, there are several ways to help ease this transition. First, help to facilitate integration into this new community. Accompany your loved one to assisted living facility events and meals to help ease the transition. Also, let them be heard. An older adult will have opinions and fears about their new situation; be there to empathize with this new arrangement.

It’s amazing how much simply being there is a big deal in helping an older loved one adapt to this new normal. Scheduling time for yourself and other family members to be present, especially early in the transition to assisted living, can make all the difference. The important thing for an older adult to know is that they’re not in this alone. Until they are more integrated into a senior living community, being that source of comfort is essential.

Finally, making wherever the older adult is staying, whether it be an assisted living facility or a nursing home, feel like home, can be a major step in easing the transition. Decorating and adorning an older adult’s room with comforts from home can make a big difference in easing the transition.

Making the Transition as a Caregiver

While the transition to a nursing home or assisted facility is hard on the older adult, it can also deeply affect caregivers. It’s important that your feelings aren’t lost in this process. Like the senior making the transition, it’s important that you’re heard. Make sure you’re surrounding yourself with people who can empathize with your situation. At the assisted living facility, there will likely be other caregivers, and forming bonds within that community can help ease the transition for you as well.

Note: There are a number of caregiver support groups available around the country that can help those that are feeling alone in their struggles to get the advice and reassurance they need. Caregiver.org is a great resource for locating support groups.

How to Choose a Nursing Home

Several factors can help determine which nursing home or assisted living facility is right for you, the first of which is distinguishing between the two options.

From there, the right facility will largely be based on need and cost (more on that later). Before deciding on a facility, it’s important to have a full understanding of the services the facility offers and what the older adult needs. For example, if the older adult needs pain management and physical therapy, it’s essential to have a nursing home that is going to provide that care. Beyond that, take an exhaustive look at what competing facilities are providing for what’s being paid. These facilities often offer everything from medical services and housing to meal plans to funding for activities; it can add up fast, and it’s important that you’re getting the best care for your money.

In terms of choosing a facility, word of mouth definitely goes a long way. If an older adult already has friends in an assisted living facility, that can make the transition much easier and take some of the guesswork out of the selection process. So ask around to friends who may have older parents, and have your loved one ask around as well; they can be a vital voice in deciding the best place for themselves.

Paying for a Nursing Home

We’re not going to sugarcoat it: the cost for assisted living facilities and nursing homes can be astronomical. The median cost of a private room in an assisted living facility in 2019 was $4,051 per month, and a private room in a nursing home was $8,517 per month. The reality is, there is no universal way to pay for care in a nursing home or assisted living facility. The best option is to consult a financial planner or elder law professional; these experts can help get a full picture of an older adult’s assets to determine what can be leveraged to help pay for a stay in one of these facilities.

Odds are, paying for stay in a nursing home or assisted living facility is going to come down to some mix of the following sources: assets from the older adult (the sale of stock or a home, for example), funds provided by other family members and caregivers, long-term care insurance, and defrayed cost from government programs, specifically Medicaid. The combination of these sources should help cover the cost of a nursing home or assisted living facility, but they can also act as factors to determine which facility is best for your loved one, as some facilities accept Medicaid coverage and some don’t. The important thing to remember is that a financial planner can be instrumental in making this decision, and it’s better to consult them earlier than later to have a broader picture of your loved one’s financial future.

Alternatives to Nursing Homes and Assisted Living Facilities

It’s best to think of elder care as a spectrum, with an older adult living at home and a caregiver checking on them periodically to make sure they’re safe on one end, and hospice care on the other. We’ve already drawn a distinction between assisted living and nursing homes, but before an older adult reaches the necessity point for an assisted living facility, there are other options available, namely in-home care, adult daycare, and continuing care retirement communities (CCRCs).

CCRCs

Think of CCRCs as an all-encompassing senior living environment. Located all on one campus, a CCRC has nursing home facilities and assisted living facilities that an older adult can move between as their needs change. Additionally, a CCRC will often have gyms, dining halls, recreation areas, and more. Essentially, they’re designed for seniors to live in for the rest of their lives (which is why they’re sometimes called life plan communities).

In-Home Care

There are many levels to in-home care, with many existing as a stage before assisted living. In-home care is often preferred by older adults because it allows them the freedom to stay in their own homes. In-home senior care is a great option for many older adults, especially in the wake of a medical emergency, because it can provide rehabilitative care from a professional, which helps alleviate the responsibility placed on a caregiver who may not have the knowledge to provide adequate medical treatment. In-home care can be a more affordable option for some older adults, but as needs change, the financial burden of keeping a home health worker on staff full time can rival some assisted living facilities. Unfortunately, medicare does not cover in-home care.

Adult Daycare

Adult day care has an admittedly demeaning name, but it is accurate. Think of adult daycare like childcare, though far less condescending once you get past the title. Caregivers are able to take their adult loved one to a facility during the day—which can especially help those who have day jobs—where they receive supervision and care as needed. Adult daycare provides valuable social interaction for older adults and a wide array of care, which can include everything from counseling and educational programs to physical therapy and other specialized services.

Recap

Placing a loved one in a nursing home or assisted living facility is one of the hardest decisions a caregiver will ever have to make and one of the hardest realities an older adult will face. When taken with empathy and understanding, however, it can be a decision that helps ensure the safety and comfort of loved ones for years to come.

FAQs

  • What happens when you can’t afford a nursing home?

    Nursing homes are a form of healthcare, and there are a number of programs that can help assist in paying for nursing home care. Older adults without the out-of-pocket funds for a nursing home may qualify for Medicaid or other government assistance. It’s always best to consult with a financial planner before deciding on nursing home care.

  • What’s the difference between a skilled nursing facility and a nursing home?

    Typically, skilled nursing facilities provide short-term, specialized rehabilitative care, while nursing homes are meant as a longer-term option for older adults that may not need specialized services.

  • What are the three most common complaints about nursing homes?

    While there are a number of issues that can occur in nursing homes, three of the most common complaints are slow responses to calls when residents require assistance, poor food quality, and a lack of facilitated social interaction.

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Comments

  1. I’m having to make a decision that I hoped we could stall or do differently. I live far from Mom…she has a cracked vertebrae due to Osteoporosis and is in rehab.Her memory issues have started going down in the past year.She is 91 so I am not surprised but am sad. She has lived on her own for many years…is in a nice apartment complex for seniors. But I’m afraid she has gotten too frail and am afraid of a fall or break .She’d broken her shoulder a year ago and broke her femur years ago. She’s a fighter…but the fight is wearing her down.She told me she won’t have surgery if something comes up-she will refuse it. Now we are trying to get her on Medicaid .She is going to have a neurological exam …She could live where I am but can she travel or will she opt for it.My heart is breaking

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